Over the past two decades, we have come to realize that the daily life and social conditions of people strongly affect their health and well-being. However, the progress to address these conditions, which are often beyond the remit of the health sector, has been slow worldwide, including the Eastern Mediterranean Region (EMR), limiting our ability to promote social justice in health.
Today, and as we delve deep into the second year of the COVID-19 pandemic, a new report has been prepared by the Commission on Social Determinants of Health for WHO which is comprised of global and regional experts. The report “Build back Fairer: Achieving Health Equity in the Eastern Mediterranean Region” highlights the opportunity to address the long-prevailing inequities, and at the same time think about recovering from the pandemic.
The report shows clear evidence of social, economic and geographic inequities in rates of infection and mortality from COVID-19. This applies across the globe, with the EMR no exception.
Although the notified number of deaths from COVID-19 in EMR is so far low, the containment measures are having very significant effects on health inequities in many countries.
Containment policies have aggravated the economic hardships already faced by the less fortunate sectors of the populations. Such measures have also been seen to lead to increased poverty, more food insecurity, lack of access to essential health services, increased unemployment and wider discrepancies in gender inequalities.
The Commission’s report highlights that those living in poverty and deprivation, or living and working in crowded conditions are at higher risk of exposure to COVID-19. These same sectors of the populations were already at higher risk due to higher rates of ill health among them. The vicious circle of poverty, inadequate living and working conditions and ill health paves the way for high rates of infection by COVID-19.
Drivers of infection are also related to certain types of work and occupations. In the EMR, COVID-19 high rates of infection among healthcare workers contributed to the spread of the virus at the beginning of the pandemic.
Several countries in EMR lacked enough resources to provide healthcare workers with the necessary personal protective equipment. Stigma, suspicion, and violence related to COVID-19 continued to target those working in front-line professions in the region.
Controlling the spread of infections becomes harder in areas of conflict, where refugees and internally displaced persons (IDPs) usually face a double predicament of fragile health systems and bad living conditions.
Out of 58 million displaced persons worldwide, almost 30 million (52%) come from the EMR. This is where access to proper health services becomes a real challenge.
Migrants and informal workers in the EMR are generally unlikely to seek healthcare or test for COVID-19 due to the risk of being quarantined and losing income. These workers are particularly vulnerable to losing their jobs and are facing more financial hardships during the pandemic. In a region where informal employment is prevalent, and particularly in low and lower-middle-income countries, the containment measures hit hard.
The dire effects of chronic inequities in the EMR continue to be exposed to the pandemic. Food insecurity, which has already been affecting the most disadvantaged groups in countries of the region, is becoming more challenging. This is expected to lead to deteriorating health conditions and higher mortality among the more disadvantaged people.
Gender inequality is a global phenomenon. With the limited gains made in some countries of the region the positive shift is expected to decline. Experts have already warned that there might be an aggravation of the feminization of poverty, further gender-based violence and an increase in child marriages as direct results of the containment measures introduced during the pandemic.
The whole world’s healthcare facilities have been strained due to the large numbers of patients suffering from COVID-19 infections. Though, as mentioned earlier, the EMR has had fewer COVID-19 related cases and deaths compared to other regions, the pandemic has impacted wider health services.
Family planning, dental, rehabilitation, palliative, antenatal and mental health services, and non-communicable diseases, diagnosis and treatment have all been affected. Also, the temporary suspension of immunization programs across the region increases the risk of the spread of infectious diseases, such as measles and polio.
Despite the somber outlook, the huge inequities, and the impact of the pandemic, there is an unparalleled opportunity in the region to become fairer.
The COVID-19 response highlights the centrality of health in our world. The pandemic offers an opportunity to rebuild trust, mend social cohesion and bring communities together. The pandemic offers a novel opportunity for an inclusive and sustainable economy.
A green recovery will have higher economic multipliers compared to the business-as-usual model of 'brown' growth, which relies on environmentally destructive economic activities. We have a golden opportunity to create more peaceful societies, capable of addressing the gender dimensions of the pandemic, while at the same time acknowledge the role of women in conflict prevention and peacebuilding.
Economic growth should no longer be the sole driving concern of governments. It should be an ambition aimed to achieve greater health for the whole population. Financial support, mental health care, better nutrition and more effective social protection systems can do wonders.
Gender-based violence should be targeted, and financial aid available for women and children in need made available.
The most significant action to show our commitment to health equity is reflected in equitable COVID-19 vaccination programs in countries of the region. Populations at risk, including migrant workers, refugees and IDP’s should be prioritized in vaccine rollout plans.
Awareness campaigns and actions should be targeted, and taken to reduce vaccination hesitancy among the most vulnerable populations.
The pandemic offers us opportunities to reduce inequalities, embrace peace, apply social justice for healthier societies where health prevails and inequities diminish.
In short, what we need in our societies is to Build Back Fairer, and the action starts with health equity. Because no one is safe until everyone is.